WESTCHESTER COUNTY CLERK RECORDING SHEET 110 Dr. Martin Luther King, Jr. Boulevard White Plains, NY 10601 ---------- THIS FORM MUST BE COMPLETED AND SUBMITTED WITH EACH DOCUMENT ---------This page is part of the instrument; the County Clerk will rely on the information provided on this page for purposes of indexing this document. To the best of the submitter’s knowledge the information contained on this Recording Sheet is consistent with the information contained in the attached document. SUBMITTER INFORMATION: Title Number: __________________________________ Company: ______________________________________________________________________________________________ Address: ________________________________________________________________________________________________ City ____________________________ State: ___________ Zip: ______________ Telephone: _____________________ Attention: _______________________________________________________________________________________________ Document type: # of pages - Mortgage Amount On page _____ of document 1st party name(s) (i.e. grantor/mortgagor) On page _____ of document Business Entity Dwelling Type: For Mortgage Only $_______________________ OR On page _____ of document [ ] 1 to 2 family _________________________________________ [ ] Consideration/Conveyance Amt: [ ] 1 to 6 family _________________________________________ [ ] $_______________________ [ ] Not 1 to 6 family _________________________________________ [ ] Check if submitted: _________________________________________ [ ] _________________________________________ [ ] [ ] RP-5217 - [ ] $125 $250 [ ] TP-584 - Type of property conveyed [1 through 8] _______ [ ] TP-584.1 [ ] IT-2663 Reference # Or Check # Mortgage Tax $___________________ _________ $___________________ _________ Mansion Tax On page _____ of document Amount Transfer Tax 2nd party name(s) (i.e. grantee/mortgagee) TAXES PAID: $___________________ _________ RECORDING FEES PAID: Amount Reference # or Check # $___________________ _________ Business Entity _________________________________________ [ ] _________________________________________ [ ] _________________________________________ [ ] _________________________________________ [ ] _________________________________________ [ ] Tax designation (Section, Block & Lot) MORTGAGE TAX AFFIDAVITS SUBMITTED: On page _____ of document __________________________________________________________ [ ] 252 [ ] 253 City(ies) or Town(s) for Property Description Cross Reference(s): On page _____ of document __________________________________________________________ [ ] 255 [ ] 260 [ ] 280 Other: ____________ [ ] 339-ee ____________ On page _____ of document ___________________________________________________________ ___________________________________________________________ Property Description -- If required, check the one contained within the document. On page _____ of document Record and Return To: ____________________________________________________ [ ] Metes & bounds ____________________________________________________ [ ] Lot number on map filed in the Office of the County Clerk [ ] Refer to deed recorded in the Office of the County Clerk ____________________________________________________ ____________________________________________________ ____________________________________________________ Revised 05/29/2009 American LegalNet, Inc. www.FormsWorkFlow.com